Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.
Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A..
Arthroscopy. 2017 Dec;33(12):2281-2283. doi: 10.1016/j.arthro.2017.07.024. Epub 2017 Oct 9.
Pseudoparalysis has been previously described as the inability to elevate the arm over 90° in the setting of a rotator cuff tear. Controversy exists regarding the optimal treatment for patients with a pseudoparalytic shoulder with a rotator cuff tear with options including rotator cuff repair and reverse shoulder arthroplasty. Recent literature suggests that pseudoparalysis can reliably be corrected with a rotator cuff repair and is more cost effective than reverse shoulder arthroplasty. We believe that the arbitrary cutoff of 90° is too generous and leads to confusion. We believe that the definition of pseudoparalysis needs to be refined to clarify indications for treatment and not base a decision on a simple measurement without other factors considered. We suggest that pseudoparalysis as a description should include elevation limited to up to 45°. The patient should also be described as having a chronic and essentially atraumatic onset of symptoms and the rotator cuff tear is massive with at least grade II to III fatty infiltration. Only with increasing precision and describing the actual patient situation and limitations will we be more able to correctly compare treatment alternatives.
假性瘫痪以前被描述为在肩袖撕裂的情况下，手臂无法抬高超过 90°。对于肩袖撕裂伴假性瘫痪的患者，存在多种治疗选择，包括肩袖修复和反式肩关节置换术，对此存在争议。最近的文献表明，通过肩袖修复可以可靠地纠正假性瘫痪，并且比反式肩关节置换术更具成本效益。我们认为 90°的任意截止值过于宽松，会导致混淆。我们认为，需要对假性瘫痪的定义进行细化，以阐明治疗指征，而不是仅基于未经其他因素考虑的简单测量值来做出决策。我们建议，将假性瘫痪的描述范围限制为最多 45°。还应描述患者的症状为慢性且基本无创伤性发作，并且肩袖撕裂为巨大撕裂，至少为 II 级到 III 级脂肪浸润。只有通过提高精度并描述实际的患者情况和限制，我们才能更准确地比较治疗选择。
